After twenty years of neglect, family planning is back at the heart of the global development agenda. Thanks to the vision and courage of the Bill & Melinda Gates Foundation and the UK Department for International Development (DfID) to reposition this crucial issue, the July 11 Family Planning Summit in London is expected to raise pledges of approximately $4 billion to provide family planning services to 120 million women over the next eight years.
This is the sensible thing to do and at the right time. In recent history, family planning programs have been woefully underfunded. Today, 215 million women lack desired access to family planning services, and too often resort to abortion when these services are not available. Many women still are not able to attain the family planning method of their choice, and commodities stock-outs remain far too frequent. Greater access to family planning is not only an issue of public health but also a matter of human rights and long-run, sustainable economic growth.
Of course, social conservatives and die-hard opponents to family planning will strike back at this argument. They will bring to the discussion canned ideology, moral arguments, and anathema. But this discourse is grounded on an insufficient evidence-base by any scientific standard, and happily most people now see through this flawed argumentation. On matters of reproduction, people in developed countries now decide for themselves despite the opinions of political or religious “pundits”. Yet many people in poor countries are still unable to make decisions in the same way.
So how will the global health community move forward following the London Summit? While principles and commitments are necessary, the primary challenge will be in the implementation. Without going into the details of whom, or which agencies are going to implement the goals of the Summit, I would like to highlight four crucial elements for the renewed efforts on family planning to succeed.
First, there must be a sense of urgency. The 16 percent or so of the world population that lives in countries where fertility is still above 4 children per woman need rapid access to contraception. Most of the 49 least developed countries fall in this category, and their population is expected to more than triple during this century. Among the least developed countries (LCDs), Bangladesh managed to reduce its fertility levels through strong leadership and door-to-door family planning programs. But most LDCs with very high fertility, in particular those in the Sahel, need action immediately as they face formidable developmental and environmental challenges.
Second, family planning must remain voluntary – everywhere and for everybody. Since the 1994 International Conference on Population and Development held in Cairo, family planning programs adhere closely to this commitment. They strive to provide high-quality services, with the proper counseling and methods of choice at affordable prices. Nonetheless, there is much room for improvement. Supply-side approaches must be combined with demand-creation efforts. Moreover, synergies between HIV/AIDS and family planning programs should also be explored.
Third, the renewed focus on family planning will be successful only if broader development goals are also taken into account. Gender sensitive policies, including universal female education as well as women’s labor force participation and legal autonomy, are also necessary. Much more needs to be done to combine family planning programs with conditional or unconditional cash transfers and income generating activities. And it’s critically important to eliminate child marriage: doing so is a sine qua non for rapid fertility declines. New mechanisms for services provision must also be tried. The result-based financing system, in which providers are incentivized to provide good services, has proven very effective in Rwanda and other countries. Such new approaches should to be scaled up.
Fourth, policymakers must keep aware of macro-demographic considerations, and the linkages between population growth and the other development sectors. In particular, they need to realize that capturing the potential benefits of a demographic dividend will require a rapid acceleration of the fertility transition. Population policies and programs also need to better define their contribution to global public goods. To achieve this, more evidence-based policies are required. The last few decades have brought a new wealth of information on population policies and programs. Still, much of this research has yet to be translated into actionable policies.
The London Summit finally brings back to the development agenda an issue that has been for too long neglected and obscured by ideology. The task ahead is huge, urgent and achievable. Let us always keep in mind that the lack of information on and free access to family planning services deprives the poorest of the poor from exerting their basic right to a better life.
The author thanks Amanda Glassman, Victoria Fan, Lawrence MacDonald, Kate McQueston, Catherine An, and Jenny Ottenhoff for their helpful comments.